Provider Demographics
NPI:1316932072
Name:KLINE, KIMBERLY (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 CREEKBEND DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044
Mailing Address - Country:US
Mailing Address - Phone:214-543-5977
Mailing Address - Fax:214-570-8579
Practice Address - Street 1:1721 W PLANO PKWY
Practice Address - Street 2:103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8634
Practice Address - Country:US
Practice Address - Phone:214-543-5977
Practice Address - Fax:214-570-8579
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113092402Medicaid